Resuscitation in Extensive Burn in Pediatrics and Fluid Creep: an Update

Purpose of review: Excessive administration of crystalloid and the abandonment of colloid replenishment at certain point of resuscitation are the major contributors to fluid overload, leading to a phenomenon termed fluid creep. Over-resuscitation in burn pediatric patients often results in fluid overload and many complications characterized by anasarca, orbital compartment syndrome, extremity compartment syndrome, bloodstream infections, pneumonia, abdominal compartment syndrome, and pulmonary edema requiring a prolonged and potentially complicated hospital stay. Recent findings: Permissive hypovolemia has been shown to effectively reduce organ dysfunction, when applied a rigorous control of diuresis. More recently, a urine output target of 0.5 to 1 ml/kg/h in the first 48 h of fluid resuscitation has become a trend in the monitoring of pediatric patients. Colloids appear to be an essential component for the resuscitation of severely burned patients. Summary: Many strategies were developed to optimize fluid resuscitation in burn patients, and until current days there are controversies regarding the most efficient method to determine the ideal volume of fluid to avoid hypovolemic shock and complications from over resuscitation as well. The success of resuscitation is related to the administration of lower fluid volumes. Some centers have demonstrated that selection of more strict protocols of fluid resuscitation, rigorous diuresis control, moderate use of opioids, and early and regular use of albumin are correlated to positive outcomes and thus may attenuate the urgence of fluid creep. © 2019, Springer Nature Switzerland AG.